Copyright © 2013 by
Archives of Razi Institute, Vol. 68, No. 1, June (2013) 71-76
Razi Vaccine & Serum Research Institute
DOI: 10.7508/ari.2013.01.012
Short Communication
An Epidemiological Study on Scorpion Stings in Lordegan
County, south-west of Iran
Vazirianzadeh∗1, B., Hossienzadeh2, M.,Moravvej3, S.A., Vazirianzadeh4, M.,
Mosavi5, S.A.
1. Department of Medical Entomology, School of Public Health, and Infectious and Tropical Diseases Research
Centre, University of Shahid Chamran, Ahvaz, Iran
2. Department of Pediatrics, faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
3. Department of Plant Protection, Faculty of Agriculture University of Shahid Chamran, Ahvaz, Iran
4. Student of Medical Sciences, Faculty of Medicine, Cardiff University of Wales, UK
5. Department of Medical Entomology, School,Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Received 13 Apr 2012; accepted 23 Sep 2012
ABSTRACT
Scorpion sting is a common important health problem in south-west of Iran. The present descriptive
retrospective study was conducted to make new information on scorpionism in the Lordegan County(20022006). Data collected in this study revealed that the highest incidence of scorpion sting cases was taken
place in spring (49.72%) in 2006. The scorpions which have brought by the pateints to the Lordegan health
centre, were identified as Androctonus crassicauda, Hemiscorpius lepturus, Mesobuthus eupeus,
Compsobuthus sp. and Scorpio maurus. The epidemiology data suggest injection antivenin of scorpions to
the victims as a good way to reduce the scorpion mortalities and injuries in this area.
Keywords: scorpion sting, Lordegan County, Southwest of Iran, epidemiology
INTRODUCTION∗
Scorpion sting is a common important health
problem in Iran particularly in south and south-western
of Iran. In Iran 192, 351 cases from 2001 to 2005 were
reported in which 104 cases terminated in death
(Deghani 2003, Dehghani et al 2004, Dehghani &
Valaie 2005, Azhang & Moghisi 2006, Dehghani et al
2010, Zayerzadeh 2011). The most of mortality and
cases of the stings have occurred in Khuzestan, a
Southwest province of Iran (Azhang & Moghisi 2006)
*
Author for correspondence.Email: [email protected]
and is endemic in Khuzestan (Pipelzadeh et al). Among
1500 species of scorpions which have been described
around the world, venoms of 50 species are dangerous
for human and most of these species are belong to
genera Buthus, Parabuthus, Mesobuthus, Tityus,
Leiurus and Androctonus of Buthidae and
Hemiscorpius from Hemiscorpiidae (Cheng 2002). The
Iranian scorpion fauna consists of over 44 named
species from 23 genera in two families, Buthidae and
Scorpionidae. But, Hemiscorpius lepturus, that belongs
to the Hemiscorpiidae family, is the most medically
important scorpion in Iran (Farzanpey 1987, Lorenco
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2001, Lowe 2010, Zare Mirakabadi et al 2011). H.
lepturus is the major cause of medical problem from
scorpion sting in SW of Iran. H. lepturus is well known
for having a potent cytotoxic venom that causes
cutaneous necrosis, deep and necrotic ulcers,
psychological problems, ankylosis of the joints, and
severe systemic pathology leading to death, severe and
fatal haemolysis, secondary renal failure and fatal
failure of the kidney (Radmanesh 1998, Pipelzadeh et
al 2007, Lowe 2010, Jalali et al 2010). Chehar Mahal
and Bakhtiari province included Lordegan County is in
the border line of Khuzestan and this species have been
reported from this province too (Farzanpey 2001).
Considerable epidemiological studies on scorpion
stings have been performed in several countries, such
as Morocco, Tunisia, Algeria, Iran, Brazil and Mexico
(Keegan 1980). Information about scorpion
envenomation in Iran is focused on Khuzestan region
however the rate of scorpion stings in the other areas of
Iran are still fragmentary and very little. One of these
areas is Chahar Mahal and Bakhtiari, a south-west
province of Iran, including Lordegan County where the
present retrospective surveying of scorpion sting was
conducted entomo-epidemiologically and medically for
the first time. Lordegan, at 31° 30′ 37″ N, 50° 49′ 46″ E,
is a city in and the capital of Lordegan County, Chahar
Mahal and Bakhtiari Province in southwestern of Iran.
Therefore, the present research study was conducted
to make new information due to scorpionism in these
regions from point of entomo-epidemiologically and
medically. This enables the local authority making the
plans to reduce and eliminate scorpion sting among the
residents of these regions.
MATERIALS AND METHODS
This research was a descriptive retrospective study.
The data of the present research came from files of
outpatient persons referred to the health center of city
of Lordegan during five years (2002 - 2006). The data
of 2002-2005 related to the frequency of scorpion
sting incidence was available according to the seasons
and only the data of 2006 was analysed completely
from point of epidemiologically. In the current study
the data of scorpion stings was studied from points of
epidemiological and medical parameters. They were
included: sex of scorpion stung victims, scorpion
stung part of body, month of scorpion sting,
geographical location of scorpion stings, possible
specimen of scorpion, medical parameters including:
injection of scorpion antivenin, interval time after
scorpion sting and injection of scorpion antivenin,
anaphylaxis shock after injection of scorpion
antivenin and route of injection. The information was
recorded in a questioner. The frequencies of entomoepidemiological and medical parameters were
converted to the percentage rank. The scorpions which
have brought by the pateints were transferred to the
department of medical entomology of Ahvaz
JundyShapour University of Medical Sciences
(AJUMS) to recognize. The scorpion species were
identified using Farzanpay's keys to the Iranian
scorpions (Farzanpey 1987). The averages of mean
daily, maximum and minimum temperatures and total
precipitation per year were considered as the
metrological data during 2002-2006 in Lordegan (I.R.
Iran Meterological Organization 2012).
RESULTS AND DISCUSSION
The results of this study were based on 635 files that
were admitted to the health centre of Lordegan during
2002-2006 with scorpion sting problem. Totally 177
files, belonging to the stung scorpion persons presented
to the health centre of Lordegan in the year of 2006,
were monitored. One hundred and sixty scorpion stung
persons (90.40%) were from rural areas of Lordegan
and the rest of 17 persons (9.60) were from the urban
regions of Lordegan. The results of this study showed
that 50.85% of scorpion-stung patients were males and
the rest (49.15%) were females. The data of scorpion
stings in 2006 is presented in the Table 1. Legs, as the
lower parts of the body were targeted by scorpion
stings (39.43%) more than the other parts followed by
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Table 1. Frequencies of scorpion sting cases according to month, season, sex and age group, Lordegan County, 2006
Scorpion stung
cases
Scorpion stung
Age
Scorpion stung cases according to the
month
cases
group
season
F
M
١٣ (8.13%)
١٧(10.63%)
١۶(10.00%)
۴٨(30.00%)
۴١(25.63%)
١٣(8.13%)
٨(5.00%)
٣(1.86%)
١(0.62%)
٠-۴
۵-٩
١٠-١۴
١۵-٢۴
٢۵-٣۴
٣۵-۴۴
۴۵-۵۴
۵۵-۶۴
+۶۵
160
٢١(11.86%)
٣٧(20.90%)
٣٠(16.95%)
٢٩(16.38%)
٢١(11.86%)
١٧(9.61%)
١(0.57%)
۶(3.40%)
۵(2.82%)
٠(0%)
٢(1.13%)
٨(4.52%)
87
٨٨
)Spring(
۶٧
)Summer(
١٢
)Fall(
١٠
)Winter(
Total
177
١٣
١٩
١۵
١٢
٩
٨
٠
۵
٢
٠
١
٣
90
٨
١٨
١۵
١٧
١٢
٩
١
١
٣
٠
١
۵
April
May
June
July
August
September
October
November
December
January
February
March
Total
Table 2. Incidence of scorpion stings in Lordegan County (2002-2006)
2002
2003
2004
2005
2006
Season/number
(%)
Season/number
(%)
Season/number
(%)
Season/number
(%)
Season/number
(%)
Winter 5 (6.75)
Spring 19
(25.68)
Summer 37 (50)
Fall 13 (17.57)
6 (7.41)
40 (49.38)
33 (40.74)
2 (2. 47)
3 (2.08)
76 (52.78)
58 (40.28)
7 (4.86)
4 (2.52)
61 (38.36)
83 (52.20)
11 (6.92)
10 (5.65)
88 (49.72)
67 (37.85)
12 (6.78)
Total 74
81
144
159
177
hands with 36% and head and trunk with 24.57%. The
distribution rate of ages the scorpion victims presented
that the greatest rate of scorpion stings victims
belonged to the 15-24 year old persons (30%) and the
lowest rate of scorpion stings were reported among the
older than 65 year old patients (0.63%). The details of
distribution rate of ages the scorpion victims are
presented in Table 1. The scorpions brought to the
medical centers by the patients or their relatives were
identified as Androctonus crassicauda (Scorpionida:
Buthidae), Hemiscorpius lepturus (Scorpionida:
Hemiscorpiidae),
and
Mesobuthus
eupeus
(Scorpionida:
Buthidae),
Compsobuthus
sp.
(Scorpionida: Buthidae) and Scorpio maurus
(Scorpionida: Scorpionidae). There were two group
data of seasonal incidence during this study. The first
data group which were recorded during a five year
period of 2002-2006 revealed that the highest incidence
of scorpion sting cases were taken place in spring
(44.72%), followed by summer (43.78%), fall (7.09%)
and in the winter as the lowest incidence (4.41%) in
Lordegan region (Table 2). The second data group
which was recorded according to the month revealed
that the highest incidence of scorpion sting cases were
taken place in spring (49.72%) followed by summer
(37.85%), fall (6.78%) and in the winter as the lowest
incidence (5.65%) in Lordegan region in 2006. The
most frequent of scorpion sting cases belonged to the
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month of May (20.90 %) and the lowest to the October
with 0.63%; however this rate was recorded zero in the
January. The rates of incidence of scorpion stings in
this study regarding to 2002-2006 according to the
season/year are shown in the Table 2 and according to
the months of 2006 in the Figure1.
Out of 177 scorpion sting cases in 2006, 161 cases
(91.53%) were recovered with using antivenin serum
including 1 cases (0.62) intra-venin and 160 cases intramuscular (99.38%) injections. The interval time after
stings and the times of injections were recorded as: 105
cases (71.92%) after 0-6 hours, 36 cases (24.66%) after
6-12 hours and 5 cases (3.42%) after more than 12
hours. All cases got back their recoveries and no case
of death was reported in the present study. No case of
anaphylaxis shock was reported after injection the
scorpion antivenin serum too.
Figure1. Frequency of scorpion sting based on month in Lordegan
County, South-West of Iran, 2006
The results of our study showed that there was not
any difference between males and females among the
patients who referred with scorpion stings to the health
centers of Lordegan County. It is in accordance with
Vazirianzadeh and Samie (Vazirianzadeh and Samie
2006) and Chitnis et al (Chitnis et al 1993) studies who
have reported no difference between male and female
victims of scorpion stings of Khuzestan. Our results are
not in accordance with the results of in Saudi Arabia
(Al-Sadoon and Jarrar 2003 and Jarrar and Al-Rowaily
2008) who reported that scorpion stings were greater in
the males than the females. Then, it is suggested that
the epidemiology of scorpion sting related to the sex of
scorpion sting cases is varied according to the year and
location of different studies. There is a sociocultural
point that the women work at homes and farms
regarding post harvest treatments the crops such as
make the bundle of vegetables or packaging the other
crops of the area and agriculture treatments, like the
men. During their works they are stung by scorpion
species. There is an economical point that the urban
region is going to be extended and developed with
more speed in Khuzestan than in Chahar Mahal and
Bakhtiari province. Because Khuzestan is an industrial
province and more mass building are being constructed
there. These building activities are being done in the
areas which are included the nesting sites of scorpion
species. But Chahar Mahal and Bakhtiari province is an
agricultural economic based and the developing
activities are being done slower than Khuzestan.
The results of this study revealed the legs (the lower
limbs) as the moving parts of man are in the greater risk
of scorpion stings than the hands and head and trunk.
This agrees with studies in Saudi Arabia (Al-Sadoon
and Jarrar 2003 , Jarrar and Al-Rowaily2008) and in
Kashan, central of Iran (Dehghani et al 2010).This
explains that using suitable wears during work in the
fields is an important issue of reduction of scorpion
sting cases. The greatest rate of scorpion stings were
happened among the 15-24 year old people. This agrees
with the findings in Kashan, central of Iran (Dehghani
et al 2010) ,Ahvaz, south west of Iran ( Emam et al)
and north-west of Khuzestzn (Ghaderi et al 2006 ). It
is assumed that scorpion sting effects the most active
age groups including the youth as students and farmers
in all of mentioned areas, if we pool two age groups of
15-24 and 25-34 years old (Vazirianzadeh et al 2008).
Data collected in the current study revealed that the
highest incidence of scorpion sting cases in 2006 was
taken place in spring (49.72%) in the Lordegan County.
This is in contrast to the studies in south-west of Iran
(Chitnis et al 1993,Vazirianzadeh and Samie 2006),
Saudi Arabia(Al-Sadoon and Jarrar 2003 , Jarrar and
Al-Rowaily 2008) and in Turkey (Ozkan and Kat 2005
and Ozkan et al 2006). They have reported that 49.7% -
akpour / Archives of Razi Institute, Vol. 68, No 1, June (2013) 73-76
93.4% of scorpion sting cases occurred in summer.
These differences were presumably due to the variation
of geographical, climatologic and species distributions
(Chowell et al 2005, Dehghani et al 2010). However,
the surveys in this area during 2002-2006 explain that
there is not a consistency regarding the dominant of
scorpion stings in the summer or spring. As the Table 1
shows that this consistency was due to the summer
during years of 2002 and 2005 and due to the spring
during 2003, 2004 and 2006. The most important data
which is considered seriously is the increasing rate of
scorpion stings during the period of 2002-2006 in
Lordegan from 74 to 177 cases. The means of
climatology data, 2002-2006, related to the degrees of
temperature and total precipitation per year do not
show any significant changes (I.R. Iran Meterological
Organization 2012). It means this increasing rate is an
independent event of climatology data. Therefore, this
increasing rate should be studied on the reducing the
prevention agents against scorpion stings among the
residents of this area. The collected species of
scorpions in the current study were similar to the
conducted studies in Khuzestan, southwest of Iran(
Radmanesh 1990, Radmanesh 1998,Radmanesh
Vazirianzadeh and Samie 2006, Vazirianzadeh et al
2008). However, the remarkable species difference in
Lordegan County from Kashan, central of Iran is
related to the existence of H. lepturus in Lordegan
County as one of the most dangerous species of
scorpion in the world. H. lepturus is only scorpion with
related cutaneous findings in Iran (Radmanesh 1990).
Presence of Compsobuthus sp. in Lordegan County is
another good reason for important of scorpionism
problem in this area, because this species cause similar
medical problem in human (Farzanpey 1987, Dehghni
2009). Totally 160 cases out of 177 scorpion stung
persons were received antivenin of scorpions. This
antivenin is a 5 ml polyvalent ampoule against 6
species including H. lepturus , A. crassicauda
Mesobuthus
eupeus,
Odonthobuthus
doriae,
Hottentotta saulcyi and Hottentotta schach. This is
made in Razi Research Vaccine and Serum Institute,
75
Iran. No case terminated to death and in all cases
recovery was recorded in the current study. This is
almost accordance to the results of Gajre and Dammas
who made a pessimist conclusion in the effectiveness
of using the earliest species-specific antivenin because
it reduces mortality and morbidity of scorpion stings in
the cases of definite envenomation with scorpions
(Gajre & Dammas 1990).
According to the results of the current study it is
concluded that the scorpion stings in Lordegan county
are epidemiologically similar to the other area of south
west of Iran regarding: distribution rate of ages, sex and
site of stings and not similar from point of season
frequency. The results of this study show that the
preventing ways of scorpion stings should be educated
among the residents of Lordegan County. From point
of epidemically, results of this study suggest, injecting
the antivenin in the persons is a useful way to reduce
the mortality after scorpion stings.
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